Provider Demographics
NPI:1902212285
Name:KHAN, MOHAMMAD TARIQ
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:TARIQ
Last Name:KHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5606 SUMMITVIEW AVE
Mailing Address - Street 2:RITE AID PHARMACY
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3038
Mailing Address - Country:US
Mailing Address - Phone:484-433-7835
Mailing Address - Fax:
Practice Address - Street 1:5606 SUMMITVIEW AVE
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3038
Practice Address - Country:US
Practice Address - Phone:484-433-7835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 60459085183500000X
NJ28RI03502200183500000X
PARP448543183500000X
MD21067183500000X
DCPH100001327183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist